As Congress debated the Affordable Care Act over 15 months in 2009 and 2010, then-U.S. Rep. Bart Stupak sought to strike a balance. A pro-life Democrat, he pushed for an amendment to maintain the existing Hyde Amendment, which banned the use of federal funds for abortions. However, Stupak didn’t want the issue to get in the way of expanding health coverage for millions of Americans. After his proposed amendment passed in the House but failed in the Senate, he and like-minded colleagues ultimately got a commitment from President Obama to uphold the ban through executive order. Stupak, who hails from Menominee and served in the U.S. House from 1992 to 2011, details the experience and passage of the health care reform law in the book, All Americans: The Dramatic Story Behind the Stupak Amendment and the Historic Passage of Obamacare. He will provide the keynote address at an event on Oct. 25 hosted by the Western Michigan University Cooley Law School and Homer Stryker M.D. School of Medicine in Kalamazoo. Ahead of the talk, Stupak spoke to MiBiz about his story and the ACA.
What’s the essence of the story you tell in the book?
I’m always an advocate for health care but I’m also a Right-to-Life Democrat and I believed that law that we’ve had for 30 years, which is called the Hyde Amendment, should stand. The Democrats in charge sort of ignored all the past laws and wanted to put through health care without all of the protections to prevent taxpayer funding for abortions.
So it came to a very interesting personal dilemma of my value and ethics. I wanted to see health care for all Americans — and 45,000 Americans die every year because they don’t have access to basic health care — yet I’m insisting on my amendment that would prevent health care from coming to the floor. What life is more important: The living, breathing American, or the unborn child who is just struggling for a chance to live?
How did the issue get decided?
We did show through the Stupak Amendment that they can co-exist, (as did) the signing and the commitment from the president that his administration would not allow funding for abortions through an executive order as they implemented the Affordable Care Act. We proved that protecting the sanctity of life and no federal funding for abortions and providing health care for all Americans — those two principles can co-exist.
What are the lessons of the last seven years since the ACA became law?
Unfortunately, what we hear about health care now is just political slogans. We don’t hear any policy. There has not been a meaningful policy discussion since we passed the Affordable Care Act. So you see these political slogans, ‘repeal and replace,’ but they never tell you with what.
This Congress has the right to repeal the Affordable Care Act if they want, but they don’t know what they’re going to replace it with because they’ve never developed or had the policy discussions that are necessary on what even President Trump had to admit is a very complex issue.
The lesson here is we all need health care. The legacy of the Affordable Care Act is people now have an expectation that they will always have access to health care. How do we provide that access?
Is health care a right or a privilege?
I’ve always said it’s a right and not a privilege reserved to those who can afford it.
Why is health care such a divisive issue?
Because it’s become political and hasn’t been looked at from a policy point of view. There have been no meaningful discussions, whether it was the presidential election or any elections, or even in Congress itself since we passed it in 2010. There is so much misinformation about health care, that over the last seven years the misconceptions over true statements have been compounded so everyone thinks it’s something terrible. If you tell people what’s in the Affordable Care Act and call it (by some other name), a majority of people would like it. You say, ‘Well, that’s the Affordable Care Act or Obamacare,’ and the majority of people don’t like it. We have these preconceived ideas.
Where does the argument need to go?
There’s no doubt there are problems with the Affordable Care Act and the argument needs to go to number one, we have the state licensing of insurance markets; number two, everybody needs to participate; number three, let’s look at what can be done to make sure we have quality, affordable health care. Just because you have a health care card or a Medicaid card doesn’t automatically entitle you to health care. Are our hospitals and our doctors and others delivering a good product back into the field to the patients who need it? This legislation needs and is crying for changes, and this is the only major piece of legislation that’s never been really changed. It’s being allowed to die on the vine.
What would you do to save it?
First of all, everyone has to participate. Either have your own insurance or (as an option) I’d go more to a public option plan as opposed to exchanges. It has to be fully funded. We passed the Affordable Care Act without adding to the deficit and without deficit spending. Then they repealed a number of the taxes. A lot of these taxes (implemented under the ACA) either have been or are scheduled to be replaced, and therefore since you don’t have the funding, the program dies.
Would you change how health care gets paid for as part of that?
Right now, we reimburse upon quantity, not quality, and when people are sick or have a disease or injury, they’re looking to get better. So how do we get them better quicker and how do we make sure that outcome is quality so they have that quality of life? We’re looking at it wrong. All we do is reimburse anybody who happens to touch the patient in the health care system.
How will history view the ACA?
History will look back and say, ‘It may not have been the greatest program ever, but this was a start in which all Americans had access to health care and received quality care.’ The Affordable Care Act started it, so hopefully Congress — maybe next spring — takes a meaningful look at the Affordable Care Act and corrects some of the problems with it and corrects the inefficiencies so all Americans can have access to health care.
Interview conducted and condensed by Mark Sanchez. Courtesy photo.